‘Add PAD indicator to the quality framework'

GPs have called for guidance on peripheral arterial disease (PAD) issued by SIGN to be extended UK-wide and for it to be added to the quality framework.  

Currently there are no guidelines for the management of PAD in the other UK countries.  

Darlington GP Dr Ahmed Fuat, deputy chairman of the Primary Care Cardiovascular Society, said: ‘PAD should be included in CHD registers and in the quality framework.’  

County Durham GP Dr Stewart Findlay, treasurer of the Primary Care Cardiovascular Society, said that guidelines for the treatment of PAD were needed and should be looked at for the whole country.  

However, he added: ‘GPs in England look to SIGN anyway.’  

He said that if PAD was to be included in the quality framework, the workload required would have to be considered.  

Surrey GP Dr John Pittard, a Primary Care Cardiovascular Society board member, said: ‘The general feeling is that PAD has been missed, so guidelines might help to improve care.  

‘The next stage would be to get PAD into the quality framework and NICE. It’s been left in isolation, that’s the perception.  

‘However, a lot of GPs will say that it will increase the workload. Ankle brachial pressure index measurements are very time-consuming.’  

The SIGN guideline focuses on lower-limb PAD, but does not deal with the prevention of disease in individuals without evidence of existing vascular disease or to individuals with critical limb ischaemia.  

Although a diagnosis of PAD can often be clear from clinical history, GPs should always examine peripheral pulses and perform abdominal palpation for aneurysm. Additionally, brachial pressure index in both legs will help differentiate between those with PAD and those with exercise leg pain.  

In cases where GPs are unsure  they should always refer, as evidence has shown PAD is a marker for systemic arterial damage.  

Young and otherwise healthy adults, presenting prematurely with claudication, should be referred to exclude entrapment syndromes and other disorders.   

Guidelines for the treatment of PAD  

SIGN guidance includes:  

Drug therapy.  

Exercise therapy. 

Cholesterol lowering.  

BP control.  

Antiplatelet therapy.  

Glycaemic control.  

Smoking cessation.  

Weight reduction.  

Vascular intervention. 

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